Ruptured Achilles Tendon

My friend ruptured his Achilles tendon when we were playing squash last week. I got him to the emergency room and he stayed in the hospital for a few days with a cast.

Initially the doctor said they would probably have to operate, but after the ultrassound they said there were no great advantages of surgery, because it was a partial rupture, near the muscle/tendon portion.

I'm not big on orthopedics, so I did some research in some books and online and from what I can tell, the treatment is still controversial. Some authors say surgery is the treatment of choice, and it has a lesser degree of recurring injury, but others say strengh and activity levels are very similar with both surgery and "conservative" treatment.

Given the location of the tear, I can understand why the doctors said they don't feel surgery is needed, I guess the surgical juntion of muscle/tendon won't be as effective, and the blood supply will be good enough for a decent healing process...

But I'm still kinda worried, I want my friend to be able to have a normal everyday life and sports activity, I don't want him to have another rupture in a year or so because this injury wasn't properly dealt with.
But then again, surgery and anesthesia have their possible complications as well... Plus my friend is overweight and smokes like 10cigs a day, I'm just imagining deep vein thrombosis (although he is just 25 years old) and other problems...

I feel responsible, in a way, because I kinda dragged him into squash. He has had a bad couple of years personally and has let himself go fitness-wise, but I felt he was doing better, getting his stuff together and wanted to help with the getting back in shape. Tried to get him to join the gym and asked him to play tennis and squash, even gave him a squash racket for his birthday...

Well, I just wanted to get this off my chest and hopefully get some experience/advice from other members on this situation.

I had a partial tear back in the mid-90s. I was on crutches for a while but never had it in a cast & never had surgery -- no medical insurance at the time. I had ankle & heel spurs at time. Perhaps compensating for those bone spurs while playing a tournament, somehow resulted in the tear. I have never had a re-occurrence of the tendon injury. Now in my late 50s, I still have very good ROM with that tendon. Even the bone spurs are no longer a problem.

i had a 85% rupture, although get this, it wasn't diagnosed properly by family doctor........ took awhile before i saw specialist.........

anyway... took a long time to heal. upwards of year........ we tried to go without surgery but it wasn't getting better (partially because i wasn't in walking boot from day 1). then i had surgery and that did the trick. although that was 6-8 months of recovery. to where i'm probably 85-90% seven years later. i think it would be hard to get back to 100%.

I had a ruptured peronal tendon this year, the one that runs from the calf to the underside of the big toe....search on my name if you want the gory details, but long and short of it, little to do but surgery. I was good to go after 3 months...been about 6 now and I barely notice a problem....

It will heal with time. Unfortunately, connective tissue such as ligaments and tendons don't have the great blood supply that muscle tissue enjoys. So healing takes a lot longer. Sounds like your friend has competent care. He should be fine.

I tore an Achilles and had surgery. Took roughly a year to get back to full speed competition. Basketball, tennis, running, it has been 12 years and so far no problems.

Surgery should always be a last option and if the doctors advise against it, don't do it. An achilles tendon blowout is extremely painful and your buddy will have trouble walking for a while, but in about 6 months, he should be walking without pain and if there is pain, it'll be minimal. Your buddy can start doing some toe raises in a few weeks, but he should wait until most of the pain has gone. Right now, he needs to give it plenty of rest. No surgery is what I recommend.

This injury sounds awful. How might one prevent it from happening in the first place if possible?

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There is still no clear evidence as to why the Achilles ruptures. In most people, there are no symptoms prior to the rupture. You hear stories all the time from folks who were simply stepping off a curb, walking up a hill, etc. when the rupture occurred. The best guess is that the tendon suffers a series of micro tears over a long period of time that results in the build up of scar tissue. Eventually the scar tissue encompasses a large enough area of tendon tissue that elasticity is compromised and a rupture occurs.

Best way to prevent injury is to give the Achilles time to heal anytime you have persistent soreness in it. Stretching your calf and lower leg when they are healthy can help. But don't overdo the stretching. The Achilles tendon is under tremendous tension and that tension is what puts the spring in your legs. It needs to be tight to do its job. All you have to do is hear one rupture to understand. It really does sound like a loud gunshot.

Surgery should always be a last option and if the doctors advise against it, don't do it. An achilles tendon blowout is extremely painful and your buddy will have trouble walking for a while, but in about 6 months, he should be walking without pain and if there is pain, it'll be minimal. Your buddy can start doing some toe raises in a few weeks, but he should wait until most of the pain has gone. Right now, he needs to give it plenty of rest. No surgery is what I recommend.

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Yes. Surgery is usually reserved for complete tears where the ends have pulled away from each other. In my case there was a large gap. The surgeon wove the tendon back together with a Kevlar-based material which provided a scaffold for the tissue to grow around. He said he could guarantee it would never rupture at that site again. But no guarantees it couldn't happen again somewhere else.

The biggest loss was jumping ability. I never regained the level of tendon tension I had pre-injury and my calf muscle has stayed roughly 2/3's the size of my other one, even after years of calf raises and running. So my vertical leaping ability dropped by about 75%. Positive is I have a very limber right leg that I can really stretch out.

There is still no clear evidence as to why the Achilles ruptures. In most people, there are no symptoms prior to the rupture. You hear stories all the time from folks who were simply stepping off a curb, walking up a hill, etc. when the rupture occurred. The best guess is that the tendon suffers a series of micro tears over a long period of time that results in the build up of scar tissue. Eventually the scar tissue encompasses a large enough area of tendon tissue that elasticity is compromised and a rupture occurs.

Best way to prevent injury is to give the Achilles time to heal anytime you have persistent soreness in it. Stretching your calf and lower leg when they are healthy can help. But don't overdo the stretching. The Achilles tendon is under tremendous tension and that tension is what puts the spring in your legs. It needs to be tight to do its job. All you have to do is hear one rupture to understand. It really does sound like a loud gunshot.

-k-

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Sounds reminiscient of my two calf tears, one in each leg, a year apart. Both occured while I was barely moving, and both felt like a gunshot. (Though I don't recall a sound.) I doubt there was much I could have done to prevent them. They both seemed to come out of nowhere.